Week 4 | Compression (17180-SP)

Photo of person using compression stocking.

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Topics

Physiology Behind Compression

  • Materials impact
  • Compression – Terms
    • Extensibility – ability to increase length with applied force
      • Elastic bandage – provides sustained compression with minor variation during exercise
      • Inelastic bandage – provides low resting pressure, higher pressure on moving
  • Types of Pressure
    • Resting Pressure
    • Working Pressure

Compression Bandages

  • Degree of compression based on:
    • Physical structure, elastomeric property of bandage
    • Size, shape of limbs
    • Skill, technique of bandages
    • Nature of physical activity of patient
  • Formulary Compression Product Types
    • Single layer – Sure Press, Seto-Press
    • Two layer – 3M Coban, others, Unna’s Boot
    • Three layer – Profore Lites, others
    • 4-layer – Profore Wraps, others
    • Others
      • Tubular compression
        • Tubigrip, Tetra-Grip
      • CirAids

What About Ace Wraps??

  • Developed in 1914 - on-line ad - “Each 3" bandage is individually wrapped, sealed and includes two clasps. Use our bandages to support and hold dressings in place, help control swelling and ease pain, or to hold ice and heat packs on an injury. These work well as an all-purpose first aid and beauty product. Perfect for your 72 hour or first aid kit!”

Sequential Compression Pump for Treatment of Intractable Lymphedema 

  • Treatment: One to two hours BID or TID

Effective Compression

  • 40 mm Hg Ankle
  • Sustained compression
  • Graduated compression
  • 25 mm Hg at top of calf
  • Know that high, multilayer compression more effective than single layer
  • BUT some compression IS better than no compression

Patient Selection for Compression Therapy

  • Cardiac Failure

Graduated Compression Stockings

  • May be ordered to provide compression from 12 -30mm Hg to 60+ mm Hg (severe edema)
  • May be difficult to apply for the elderly, obese, those with arthritis or poor hand strength
  • Elasticity decreases with time/washing - replace every 6 months

How to Measure for Stocking Fit

  • Measure with tape measure around the smallest part of the ankle, above the (malleoli).
  • Next measure around the fullest part of your calf.
  • For thigh, thigh with waist attachment or pantyhose styles also measure around the fullest part of the thigh.
  • Measurement from floor to crease in bend of the knee or to buttocks may be needed to determine Regular or Petite length

Chronic Venous Insufficiency

  • Progressive primary reflux disease secondary to varicose veins – 1/3 to1/2
  • Others follow a DVT – 1/3 cases

Suggested Compression

  • Patient S/P ulcer -- Use 15-20 mm HG as maintenance or higher if tolerated
  • Venous ulcer open, good ABI -- Use 30 – 40 mm HG to close
  • Mixed disease - Venous ulcer open, no arterial wound -- Use 12-15 or 15-20 mm HG
  • At risk leg -- Use Unna’s Boot per Dr. John McDonald

Stocking Application Assistive Items

  • Stocking Donner
  • SlippieGator from Juzo

A.C.O.R.E. Principles

  • Optimize the local wound environment
  • Remove devitalized tissue
    • surgical, autolytic, enzymatic, etc.
  • Maintain a moist wound bed
    • occlusive dressings, hydrogels
  • Absorb excessive exudate
    • alginate dressings, foam
  • Protect surrounding skin
    • skin prep, zinc-based ointments (??)

What about Topical Dressings?

  • Variety available – no one is superior – base on wound condition

A.C.O.R.E.

  • Review contributing factors that adversely affect wound healing

A.C.O.R.E. Principles

  • Establish maintenance plan using long term compression therapy
  • Follow-up care
  • Patient Education
    • Disease process
    • Prevent trauma
    • Early intervention for recurrence
    • Life style changes needed

Surgical Options

  • Saphenous vein stripping - maybe not
  • Sclerotherapy – now being touted as best choice IF patient qualifies
  • SEPS (subfascial endoscopic perforator surgery)
  • Linton’s procedure
  • Skin grafting
  • New approaches coming


Patient and Family Education

  • Sustained compression - required for life!
  • Walk, exercise
  • Elevate legs
  • Weight reduction
  • Smoking cessation

Remember - Assess patient first, assess wound needs, select correct action in dressing material

Apply, but with compression

  • Only evidence for venous ulcer closure!
  • Get edema under control before ordering stockings

Objectives for Learning Outcomes

After completing this session, you will be able to:

  1. State terms used to describe compression products 
  2. Teach others about the impact of compression on vascular components. 
  3. Select appropriate patient products from those available for use. 
Course summary
Available: 
04/07/2017
Expires: 
07/02/2018

Betty Hanrahan, MSN, CNS, ARNP-BC, CWCN-AP, CWS, FACCWS, CFCN
Certified Wound Care Nurse; Co-Director, Wound Management Education Program (WMEP) and Wound Management Fundamentals Course (WMFC), Continuing Nursing Education, University of Washington School of Nursing, Seattle; Fellow, College of Certified Wound Specialists

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